Challenges Persist for HCPs and Patients With Breast Cancer

Reshma Mahtani, DO

As the treatment options and protocols for patients with HER2-positive breast cancer continue to evolve, health care professionals (HCPs) must adapt their practices to align with changing guidelines. This can present difficulties in creating treatment plants, managing adverse events, and improving patient care. However, the gaps that exist between HCPs and patients can be improved upon, according to Reshma Mahtani, DO.

In an interview with Targeted Oncology^TM, Mahtani, chief of breast medical oncology at Miami Cancer Institute, Baptist Health South Florida, discussed findings from a quality improvement initiative that was presented at the 2023 San Antonio Breast Cancer Symposium identifying and addressing challenges health care professionals face when treating patients with HER2-positive breast cancer.

Targeted Oncology: Can you provide some background on the initiative and what prompted it?

Mahtani: The rapidly evolving evidence in the treatment of metastatic HER2-positive breast cancer presents challenges in aligning practice with the latest clinical data and guideline recommendations, especially for physicians that treat multiple tumor types. Our study was a quality improvement initiative where we sought to identify and address real-world challenges health care professionals face in individualizing treatment plans, adverse event management, and patient-centered care for HER2-positive breast cancer patients specifically.

Can you summarize the findings of the initiative and what implications they may have for physicians?

Over a period of 3 months, in 2022, we surveyed health care professionals who treat patients with HER2-positive breast cancer as well as patients with HER2-positive metastatic breast cancer from large United States community oncology clinics, and we assessed practice patterns, challenges, and attitudes related to individualized and patient-centered care. Patient charts were also audited to assess current practice patterns and track changes over time. The health care professionals then participated in live audit feedback sessions to assess site-specific challenges and gaps and developed action plans for improvement.

In terms of our findings, the top reported health care professional challenges included coordination of care [and] individualizing treatment plans, whereas the top patient-reported challenges included things like feeling confident in their treatment plan and being unable to meet work or home responsibilities.

It was interesting to note that in our tethered surveys, there were discordant findings between patients and health care professionals’ perceptions related to goals for treatment, patient education, and patient-centered care. An example of that would be 82% of health care professionals reported often or always asking patients about treatment preferences, but only 8% of patients reported that their doctor asked. Another example was that health care professionals overwhelmingly thought surviving as long as possible was their patient’s top goal. However, patients reported their top goals for treatment were things like improving quality of life and controlling symptoms.

Are there any next steps for the initiatives? How can physicians use these?

There are next steps that we have planned. Follow-up chart audits and health care professional surveys will evaluate changes in practice patterns 6 months after the educational intervention.

How can physicians use some of these findings in their own practices?

I think the key take-home message from our work is that there are clearly opportunities for improvement in providing guideline-aligned care, as we identified gaps in understanding treatment selection, sequencing, and supportive care measures. What I found personally most striking is the discordance in perceptions between patients and those who care for them. Our work highlights the importance of looking at our own practices in identifying areas where there is room for improvement and developing concrete strategies to implement these changes. Also, the importance of checking in with our patients to make sure we're all on the same page, so to speak, in terms of goals of therapy.